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Reperfusion Ectopy



The first seven beats on this strip have wide QRS complexes (about 0.14 seconds) that are not preceded
by P waves.   The R-R interval is 0.80 seconds, thus the heart rate is 75.  This is an accelerated junctional
rhythm with a right bundle branch block.  These beats are followed by sinus beats with normal duration
QRS complexes, except for the 11th QRS, which is wide.  The rate is essentially unchanged.  This patient
was having a myocardial infarction (note the Q-waves and the ST changes in leads II and III) and has been
given the thrombolytic TPA, which often gives rise to this pattern of benign ectopy.